Disparities Report, which tracks the inequities in health services in the United States. Since the report was first published in 2003, the findings have consistently shown that while we have made improvements in quality, we have not been as successful in reducing disparities in healthcare. This dichotomy has resulted despite the fact that we continue to spend more on healthcare. Healthcare costs have been escalating an unsustainable rate, reaching an estimated 17.3 percent of our gross domestic product in 2009 according to the Centers for Medicare and Medicaid Services (CMS). Despite these high costs for the provision of health services in the United States, we continue to observe delivery system fragmentation and inequities in the quality of healthcare delivered. Likewise, when we look at the disparities in health status and access to care for racial and ethnic minorifies, the numbers are quite alarming! Each year approximately 83,000 racial and ethnic minorities die as a result of health disparities and as a nation we are spending an estimated $300 billion as a result of these disparifies. When we add in the social determinants of health - realizing that healthcare alone cannot adequately improve health overall or reduce health disparities without addressing where and how people live - you can see how complex this issue is. Despite the fact that health equity is a key component of the transforming journey of healthcare that we are all embarking on, little has been done to comprehensively and trans-disciplinarily coordinate health policy research, analysis, and collaboratively address this serious problem at the local, state, regional, and national level. With the passage of several health-related policies in recent years, the focus has been on bending the cost curve and becoming more efficient with less moving fon/vard. While it may be difficult to predict the unintended consequences of many of these policies, by leveraging the collective strengths and expertise of our partners we can tackle the grave health disparities confronting racial and ethnic minorities. One significant health policy being advanced is the ACA, which includes provisions addressing health equity and the elimination of disparifies in health status and healthcare among vulnerable populations. The ACA includes health equity-related provisions, which provide a bridge to health equity that affords marginalized groups - particularly racial and ethnic minorities - increased access to culturally appropriate care, quality healthcare, preventative care, and comparative effectiveness research. For racial and ethnic minorities who are the most likely to be uninsured, experience higher unemployment rates, and have a lower income - which makes it harder to obtain employer-sponsored health insurance coverage - Medicaid expansion and the creation of health insurance exchanges would provide these communities access to vital health services. In addition, the ACA provides a unique opportunity to expand the scope of research related to health disparities, increase diversity in clinical trials, and identify, develop and distribute appropriate interventions and solutions to address these disparities. The law also provides new investments to increase the number of culturally competent primary care physicians and other health professionals. For these reasons, the implementation of the ACA offers a critical opportunity to realize the goal of achieving health equity throughout our country. The recent Supreme Court ruling on the ACA, while essentially weakening a key aspect of the ACA's efforts to expand health insurance coverage to the working poor - Medicaid Expansion - by making the expansion of this program optional for states, nevertheless upheld the ACA and the provisions aimed at addressing health disparities. As a result, MSM will help states within Region IV strengthen their health equity and health reform agendas, and inform other states of lessons learned.